7 April 2017

How we can add to the good lives of older people

Older life

Over the last decades, a considerable amount of research has been focussed on children and young people who are, of course, our future. But at present more research is going in the direction of promoting the good lives for the elderly – says Professor Inge Tetens, head of the new research centre “Centre for Good Older Lives” at the University of Copenhagen and the Food Culture Association (Madkulturen). In building research-based knowledge, the Centre aims to create a new framework for the older part of life for the individual and for society around food, nutrition, meals, physical capacity and meaningful relationships within an economically sound frame.

Picture of elderly person

What is the aim of Centre for Good Older Lives?

The long term overall aim of the new centre is to add to the good lives of older people. The focus is on quality of life – and quality of life as something more than merely the absence of disease. It is about being able continuously to handle everyday tasks, and being able to cope with the challenges that inevitably arise as one gets older – for example, when members of your family and acquaintances pass away, and you become more isolated.

What exactly is the good life in old age?

In the context of ageing, the good life comprises various aspects of life, and one of the most important ones is the maintenance of functional capacity – to be able to maintain daily functions yourself and maintain your independence. “Quality of life” does not necessarily imply that you are still able to run after the bus or travel abroad. It may be to be able to get out of bed and get dressed in the morning when you want to, and not be dependent on others. For many people being independent is highly valuable.

In addition, “quality of life” also includes aspects such as remaining with your family, keeping your circle of friends or engaging with others in the community. In the experience of many older people, their family members and social relations disappear, and for those who are left behind, it may be a challenge to achieve the “good life” of what remains. When you are elderly, good food, good nutrition, exercise and good relationships can make a big difference, which we need to be more aware of.

The Centre for Good Older Lives will study in more details what it takes to maintain functional capacity and quality of life around food, nutrition, meals, physical capacity and meaningful relationships for as long as possible. We will also study the impact on the economy at the individual and the societal level. It is no secret that funding for senior services is not unlimited in the current political climate in Denmark, and this is unlikely to change in the coming years.

“Good meals, exercise and meaningful relationships do not ensure eternal life, but until your last day, you need to feel as hale and hearty as possible. At the Centre for Good Older Lives, we are studying how older people can maintain functional capacity and a good quality of life as long as possible through optimal meals, exercise and meaningful relationships, for the benefit of both the economy and the individual. To address demographic challenges in the global society, we need new approaches to the efforts being undertaken in relation to the elderly, and Denmark has a good opportunity to be at the forefront,” says head of the centre, Professor Inge Tetens.

Professor and head of the center Inge Tetens

"Good meals, exercise and meaningful relationships do not ensure eternal life, but until your last day, you need to feel as hale and hearty as possible. At the Centre for Good Older Lives, we are studying how older people can maintain functional capacity and a good quality of life as long as possible through optimal meals, exercise and meaningful relationships, for the benefit of both the economy and the individual. To address demographic challenges in the global society, we need new approaches to the efforts being undertaken in relation to the elderly, says Professor Inge Tetens

So there is also a big economic incentive to create the Centre?

The reason for the centre’s work is the demographic changes in the population. There is a growing number of older people – especially the number of the very old. This means increased costs for society, but we also see this as an opportunity to take advantage of the huge potential for prevention activities. Some elderly people need a great deal of support in everyday life, but a large proportion of older community-dwelling people are also likely to benefit from our research, where one of the goals is to quickly implement the results into daily practice.

By ensuring the good life in old age, society will also have to spend less on the elderly – so there is both a social angle and an individual one. The fact that you lose some of the functionality that you have had in the past is a natural part of growing old. However, if we – through good nutrition, good food and meals, opportunities for physical activity and social life – can create better lives for the elderly in an economically sound manner, it will make a big impact. Our task is to devise the research that can support the elderly to live a good life and support policymakers to make evidence-based decisions about the elderly.

There are already many good initiatives in this area – for example, in many municipalities in Denmark. One of the issues though is the lack of scientific evidence for the effectiveness of the initiatives. Here, we can use our scientific approaches to measure the results of various interventions. Thus, as a centre we will not always have to invent new initiatives: we wish to approach the task with a certain humility and bring scientific evidence to the initiatives that already exist and are known as “best practice”. By identifying the most effective methods and ensuring their use across the country, we can thereby find what is most beneficial to society. It is a big task, but one that has great potentials. Moreover, as demographic changes in the population is a global challenge, one could imagine that there will be an export market for the solutions we identify – and in this case, resource economics, one of the centre’s research areas, will play a significant role.

Can you give specific examples of initiatives that the centre could improve on?

One example is the centre’s collaboration with the research project ELDORADO, which, among other things, examines the different elements of the municipal meal delivery service. ELDORADO is about optimising the sensory quality of foods and assessing how to use technological solutions to foster social relationships within the homes of the elderly. The project also addresses new ways of preparing meals, which may affect the nutritional value, the environment and sustainability and how these may benefit the economy.

ELDORADO is just a start in this field, and one could imagine expanding the focus to the entire supply chain: from the production of the raw materials to the choice of food and the preparation for the elderly - from packaging and transport to the way the food is eaten – and for instance, in which surroundings and social contexts. This chain of meal delivery systems produces a number of challenges for the municipalities, but there are great potentials in developing techniques that can improve both the coherence of the municipalities’ tasks and the satisfaction and quality of life among the elderly. However, this area could, if you are not careful, lead to very high costs for the municipalities.

In the senior sector, it is necessary to take into account the fact that the elderly are not a homogeneous group, which means some huge practical challenges. Perhaps in relation to a meal delivery programme, we should offer the possibility of choosing a beef patty without fried onions for those who cannot stand fried onions. Perhaps we should present food in a more visual way with pictures to stimulate the appetite rather than just a menu with text. We know that some municipalities have already initiated more choice options for the elderly. Here we would like to assess the various factors relevant for the recipients. Are they happier? Are they healthier? The Centre has the scientific background required to measure the physical capability and satisfaction of these individuals.

We have been talking about the elderly with poor appetite, but other older people have very different challenges that should also be addressed. One option would be to study how much muscle strength could be maintained or increased among the elderly by optimizing the nutritional status of i.e. vitamin D. An optimal vitamin D status has been shown to reduce the risk of falls, which is a major health risk in the elderly population group. There is a whole range of other measures that can have a preventive effect in relation to the loss of functions among the elderly. It is the task for the Centre to identify the best partners to collaborate with in such tasks.

The Centre also aims at considering the structural changes in society that could contribute to solving some of the daily challenges we face both in senior services and with younger families with senior members. We talk a lot about the busyness and lack of time in families, and the fact that children lack contact with adults, this could be addressed by supporting cross-generational activities between children and the elderly. Our scientific approach can be used to investigate which initiatives could be introduced from the private or municipal side, in order to support the good life.

Who are the obvious partners in the field?

The Centre’s research area suggests a cross-disciplinary approach at the research level, but we also aim to ensure the cross-disciplinary approach through a research advisory board consisting of multidisciplinary stakeholders and experts. It is this approach in particular, which is one of the Centre’s major strengths. We cannot cover this huge area alone without having a close collaboration with various stakeholders. For us, it is extremely important that they have a say in the initiatives we choose to research. As a result, we also have a steering committee whose members – in addition to the Centre’s four stakeholders (see box, ed.) – represent a number of key players in the senior sector.

Other organisations and research centres are also working with the great challenges of the ageing society and we really need to collaborate. At the University of Copenhagen, we have, for example, the Centre for Healthy Ageing at the Faculty of Health and Medical Sciences, while the Centre for Good Older Lives comes under the Faculty of Science. The Centre for Good Older Lives has a very practice-oriented approach, which builds on the basic research that already exists, and to which the Centre for Healthy Ageing has already contributed a great deal.

For the Center for Good Older Lives’ part, we are talking about applied research, using intervention research aimed at direct implementation in the senior sector. We are focusing on prevention through food, exercise and good relationships as opposed to treatment, and we also consider resource economics. Our scientific toolkit is based on the scientific research subjects of the centre’s owners, which include food processing, food chemistry and microbiology, sensory and consumer science, nutritional science and physical activity. I predict that there are a number of areas, where the Centre for Healthy Ageing and the Centre for Good Older Lives could find themselves complementing each other.

Do you think that prevention in the senior sector has been overlooked in terms of research?

Denmark actually has a long tradition of research into the elderly. However, within the Center for Good Older Lives’ main areas of interest – food, nutrition, meals, physical capacity and meaningful relationships – there has been a strong focus on children and young people in the past. This focus will of course, be continued in the future, but it is time to focus also on the last part of life, which is getting longer and longer. Now that we are collectively becoming increasingly older, it makes even more sense to work on prevention to ensure that this part of life is as good as possible for each individual within the frame of resources available.